"Don't Let the Frostbite BITE"

Who doesn't love FROZEN? Our family can't stop singing the award-winning songs from Disney's latest musical hit, so I couldn't resist borrowing a line for my blog title today...However, frostbite is no laughing matter, and with the record low temperatures we have had this year, I thought I should say a few words about this cold weather danger.

What is frostbite?
Frostbite occurs when ice crystals literally form within the tissue in our fingers and toes and noses, damaging and often completely destroying the cells in the skin. Frostbite shows up when it the thermometer reads in the negative in Celcius or below minus 17 in Fahrenheit. Remember, though, that wind chill can push the "real" temperature below the numbers you see on your favorite weather app!

Risk factors besides the extremely low temperatures include alcohol use, smoking, diabetes, previous cold injury, low calorie intake, lean body mass and history of Raynaud's phenomenon (where the blood supply to the hands gets restricted and your hands turn red/purple and ache terribly.)

What are the signs and symptoms?
Frostbite manifests as very painful, severely cold, and initial white and numb areas that progress to blotchy, swollen redness in the tip of your nose or the ends of your fingers and toes. While the affected areas hurt, they are also typically numbed (you can't feel someone touching the end of your finger/toe, but you have pain in that area). With second and third degree frostbite, blisters and "blood blisters" appear, and in fourth degree frostbite there is actual gangrene (rotten, dead tissue).

PREVENTION is KEY
Dress your core in LAYERS, cover all exposed areas, avoid alcohol (or any drugs that can alter mental status), and stay inside if the temperature is below negative 10*. HOWEVER, be aware that if you try to layer socks or gloves, you may end up with excessively tight, constrictive layers that can actually make you MORE likely to get frostbite. Also, remember to remove rings (fingers and toes) before skiing or other cold weather activities.

What is the Treatment? 
Remove any jewelry if present. Immerse the affected areas in warm water and take NSAIDS (ibuprofen) and quickly SEEK MEDICAL CARE. Do NOT rub affected areas, as this may actually increase tissue damage.

BOTTOM LINE: Watch the temperatures, especially if you are traveling to an area that is much colder than you are used to experiencing, and make sure you have gloves, socks, and face gear that is made for sub-zero weather challenges if you plan to be outdoors in below zero weather!

What's Hookah?

What's Hookah?? In the past few years, instead of asking my patients "Do you smoke?" I have learned to ask  "Do you smoke? (pregnant pause)...ANYTHING?" I found that asking in that manner greatly increases my yield. Couple that with Colorado's legalization of marijuana, and more people are freely sharing the full extent of their substance use with their doctors. Which left me asking the question, "what's hookah?" (I could add here that I was also asking "what's shisha" and "what's snus"?)

Hookahs are water pipes used to smoke flavored tobacco. The flavors are often sweet- chocolate, cherry, licorice or fruit flavored. The heat source is charcoal, and the vapor/smoke goes through a water basin before being inhaled. A common misperception is that this "purifies" the tobacco, so that the smoke is no longer harmful. Hookahs can have multiple tubes allowing several people to inhale at one time, or users can pass around the mouthpiece and take turns inhaling (obviously sharing germs as well as the hookah vapor).  Hookah bars seem to be multiplying across the United States, especially in college towns. Austin, Texas, is no exception. A 2013 study of 7 large universities showed that 1 in 10 college students used hookah.

Although hookahs has been around for centuries, we certainly do not have a plethora of double-blind, placebo-controlled meta-analysis studies to clarify exactly the specific health risks of long term use of hookah. What do we know?

• Hookah smoke is "at least as toxic as cigarette smoke" (CDC, 2013)
• Hookah tobacco and vapor contain the same poisons that cause mouth, lung and bladder cancer
• Hookah sessions are usually much longer than cigarette breaks- often up to an hour, increasing the toxin exposure up to ten times higher than traditional smoking
• The nicotine in hookah tobacco and vapor is very addictive (just as in cigarettes)
• Smoke from the heat source, charcoal, can cause carbon monoxide poisoning
• Gum disease is 5 times more common in hookah users than cigarette smokers

BOTTOM LINE: Hookah (water pipe) smoking is NOT a "safe" alternative to cigarette smoking- don't take up this habit! 

CVS Quits Smoking!

Congrats to CVS pharmacy for taking a stand for HEALTH and announcing that they will completely quit selling tobacco products by October 1st of this year! While, yes, consumers can choose to walk across the street and head into another store to purchase their cigarettes, I am hopeful that other major pharmacies and grocery stores will consider this same step. As people have heard me say repeatedly, there is NO amount of tobacco that we believe to be actually GOOD for your health.

Every single day in the United States, there are over 1300 deaths attributed to smoking. How can you picture what that means in terms of human tragedy? Imagine two enormous jumbo jets colliding- which would mean approximately 1200 people dying...and think about how many times we would see that ghastly image on our computers and televisions. I want young people starting to smoke to have THAT image printed on their brains, rather than associating smoking with fun, alcohol and parties.  Did you know that the vast majority of long-term smokers began the habit before the age of 21? I cannot tell you how many soccer moms my age, as well as professionals of all sorts, are still closet smokers- hating their addiction and wanting to quit. Many picked up "social smoking" in college fraternities and sororities, thinking it was no big deal...and that they would stop that habit after they graduated. Now it is ten or twenty years later, and they are hiding this addiction from their peers and especially their children. I believe it may be easier for people who smoke openly to quit, because at least they can enlist the support of their friends and family!

If you are still smoking, please talk to your family doctor about all the medical options to help you quit, and think about setting a quit date in 2014. Your habit didn't form over night, and the average serious smoker takes 7 tries to quit for good. Nicotine replacement medications (gum, patch, nasal sprays, inhalers and lozenges)  have been shown to increase your chance of successful smoking cessation by 50-70%. Other medications such as Chantix & Zyban double or triple the success rate as well.

BOTTOM LINE: Smoking doesn't "just" cause lung cancer (and many other cancers), it causes heart attacks, strokes, and really crummy quality of life with chronic bronchitis and COPD (Chronic Obstructive Pulmonary Disease). If you still smoke, please make an appointment to talk to your family doctor about quitting. You CAN do it!

Sugar for Your Sweet Heart??

As Valentine's Day approaches, our thoughts turn to HEARTs, right? And maybe chocolate? Perhaps...but we also need to think about the heart muscle keeping us alive right now, and we have yet another medical study that shows the EXCESS SUGAR in our diets is taking a toll on our heart health.

The recently published Journal of the American Medical Association report, "Added Sugar Intake and Cardiovascular Disease Mortality Among US Adults"  confirmed that American adults consume too much added sugar (such as the sugar we directly add to coffee and foods, as well as the "added sugar" in sodas, fruit juices, pastries, and chocolate) with 10% of us getting over one fourth of our daily calories from this category! In addition, people whose diets have over 21 % of their calories from added sugar have a significantly increased risk of heart attacks and strokes- DOUBLE the risk of those who limit these sugars to less than 10% of their diet. If you bump up the daily percentage of added sugar to over 25% of the daily calories, that risk almost TRIPLES.


Now this may seem fairly obvious, because we know obesity is linked to cardiovascular disease, but the interesting part to me is that this increased risk held true even when factoring in our known risk factors such as  obesity, low physical activity, and high cholesterol. 

Additionally, this study noted that those of us drinking a sugar-sweetened beverage every day (more than 7/week) also have an increased risk of cardiovascular disease compared with those who do not. Keep in mind, a soft drink at a restaurant is usually TWO servings, not one, so even one of those every other day would count. I would also like to take this opportunity to point out that drinking one regular (not diet) soda per day will add on 15 pounds per year...so there is definitely some benefit to changing this habit! Sodas are not the only culprit, of course, please note that fruit juice is on the list (yes it has some vitamins in it, but you are better off eating the whole fruit) and the daily coffee addiction can add tremendous numbers on the scale if you are not a "black coffee" kind of person. But I digress...

BOTTOM LINE: Let's become conscious of the "added sugar" in our diet, and make it less of a habit and more of a treat...and our HEARTS will thank us!

Can't Stop Sneezing?

Ah, the beautiful golden mist floats above our Austin trees...ACHOO! It's cedar fever time in central Texas, and many of us are suffering. Itchy eyes, runny nose, sneezing, stuffy nose, ear pain and very sore throats are all part of the package. Often people are afraid they have the flu or strep throat, because their symptoms are so intense, but one clue with allergies is the LACK of a fever- while you might have an elevated temperature of 99-100*, allergies don't cause the 101-104* fevers and chills that infections can trigger. That being said, some of the most PAINFUL sore throats can come from "just allergies"...so be sympathetic to your suffering friends and family.

What is the best treatment for seasonal allergies? 
First line treatment for seasonal allergies includes both oral non-sedating antihistamines (like brand names Allegra, Claritin & Zyrtec, now all over the counter) and nasal steroid sprays (such as Nasonex, Flonase, Veramyst, etc.- require a prescription.) My personal preference for someone who truly has daily symptoms during a given season, especially with significant nasal congestion, is to start with these nasal steroid sprays. These are not "pump you up" steroids, but anti-inflammatory steroids that only act locally in the nasal membranes, creating sort of a protective barrier in your nose; blocking irritating pollens from ever causing that release of histamine that triggers all the itchy, runny, drippy symptoms. When I see a patient who suffers from nasal congestion, drainage, etc., "every" winter or spring, my plan is to get them started on these nasal steroid sprays a week or so before that season the next year, in the hope of preventing symptoms from ever starting.


There are also prescription nasal antihistamine sprays, which are very effective in drying up dripping noses, but are limited in many people by a rather nasty aftertaste. (Leaning forward as you use this type of spray can greatly reduce this side effect).

Another oral medication that works very well for seasonal allergies (when taken daily throughout a particular season) works by targeting the immune response via a "leukotriene antagonist"- don't worry about the specifics here, but know this pill effectively limits the body's allergic inflammatory response. The trade name of this drug is Singulair, and it is used both for seasonal allergies and for asthma. Many physicians use this drug as a second line of defense when the daily nasal steroids are not enough, especially if people are having too much sedation or dryness as a result of oral antihistamines.

Allergy shots from an allergist may also be a very effective option, but because they require a significant time and financial investment, we reserve this treatment for patients more severely affected.

BOTTOM LINE: If you have had a stuffy nose for weeks or are having fits of sneezing or itchy eyes, ears or throat, talk to your family doctor about treatment options both NOW and in anticipation of your next allergy season.

Gardasil- What's Up Down Under?

The HPV (Human Papilloma Virus) vaccine, Gardasil, was FDA approved in the United States for use in young women in June, 2006, then extended for males in October, 2009. In October of 2011, the Advisory Committee on Immunization Practices (ACIP- the group that creates our national guidelines that you see posted on your doctor's office walls) extended their official recommendations to include ROUTINE VACCINATION of both boys and girls at age 11-12 years, with "catch up" immunizations for those youth  ages 13-21 who had missed getting this vaccine series.

Why are we vaccinating?
We vaccinate primarily for CANCER PREVENTION. Each year in the United States, we have over 33,300 cases of HPV-related cancers (data from CDC, 2012). About 2/3 of these occur in women, primarily with cervical cancers, but also other genital, anal and oral cancers. In men, the majority of HPV related cancers are oral, but they, too, can have genital and anal cancer, though it is less common than in females.
Gardasil also protects against the two strains of HPV that cause 90% of genital warts, and with over one million cases of this malady each year in the US, you can see what an impact prevention can make here!

How well are we doing?
Not as well as we could do...because national immunization surveys have shown that in teenagers 13-17 years old, only 53% of young women had started the series, and only 1/3 of that group had completed the series. A bit more encouraging is an improvement in the very low percentage of teenage males getting the vaccine, which was at 8% in 2011 (the first year it was considered a "routine" universal vaccine) and more than doubled to over 20% in 2012.

How effective is this vaccine? Here is the GREAT news- the HPV vaccine is unbelievably effective when given to young adults not previously exposed to HPV (with no prior sexual intimacy). The CDC's data demonstrates efficacy nearing 100% protection for women in preventing cervical, vulvar & vaginal cancers and genital warts, and 90% efficacy in men for genital wart prevention and 75% efficacy preventing early anal cancers.

What happened down under? 
From 2007-2009, Australia provided the HPV vaccine free of charge to all young women ages 12-26, and had extremely high vaccination rates as they utilized the school system to give out these shots. Follow up studies in 2011 and 2012 showed dramatic results, with 92% decline in genital warts in young women (< 21years old),  72% decline in women ages 21-30, and interestingly...an 81% delicate in young (< 21) heterosexual men and 51% decline in men ages 21-30. This is interesting because the young men saw improvement not because they had been immunized, but simply from the widespread immunization of all the women. Pre-cancerous cervical abnormalities also markedly declined in this short time period, and since cervical cancer typically is very slow growing, we expect to see dramatic falls in cervical cancer rates in the next few years and certainly, in the next decade.

BOTTOM LINE: HPV vaccination SHOULD BE a routine immunization for our sons and daughters- talk to your family physician about it at your next visit*

(In this day and age, I feel compelled to add two things: one, I in no way financially benefit from the makers of the Gardasil vaccine; two, yes, we chose to vaccinate our daughters.)

Resolutions for BETTER HEALTH in 2014

Happy New Year! Many people start each year with resolutions surrounding their health, so I'd like to  jump in and suggest that you put one EASY resolution at the very top of your list. This resolution should take up well less than an hour of your life, yet can make a tremendous difference in your health for 2014...so here it is: GET YOUR ANNUAL FLU VACCINE!

If you have already received yours, pat yourself on the back & remember to encourage your friends and family to get theirs. I will confess that certain members of my family kept putting off their shots for a variety of reasons (including one trip to two pharmacies who were temporarily out of the vaccine last month), but we are 100% vaccinated now. My major message is two-fold: one, it is NOT TOO LATE in the season to get a flu shot, and two, just glance at the CDC's map above to see how widespread the flu has become this year! Last year, influenza caused over 380,000 people to be hospitalized. This flu season, we are seeing a resurgence of the pH1N1 strain (originally known as swine flu, though the "p" is for "pandemic", not pig). This particular strain is the type of flu that was so severe in 2009, but happily, all of the current flu vaccines DO include this strain. Note that pH1N1 can produce very severe illness, especially in young and middle-aged adults.

More questions about the flu or the flu vaccine? Check out "I Got Mine" or the CDC's "Flu Basics".

BOTTOM LINE: Start 2014 off right & GET YOUR FLU VACCINE (if you haven't yet this season).